Robert Finn

An 8-year follow-up study from a randomized, controlled trial of repeated prenatal ultrasound examinations found no evidence of any lasting harm to any aspect of child development.

The initial study demonstrated that infants exposed prenatally to five ultrasound imaging studies between 18 and 38 weeks' gestation had a significantly greater risk of low birth weight than children exposed to only a single ultrasound at 18 weeks of gestation.

Included in the follow-up analysis were 1,352 children who previously had been randomized to the regular ultrasound group and 1,362 children randomized to the intensive ultrasound group (Lancet 2004;364:2038-44).

After 8 years of repeated follow-up examinations, children in the two groups showed no statistically significant differences in a wide variety of developmental measures. These included measures of physical growth, toddler temperament, language development, and behavior, reported John P. Newham, M.D., of the University of Western Australia (Subiaco), and his colleagues.

The groups showed a statistically significant difference on only a single measure of child development. At 1 year of age children in the intensive ultrasound group showed a smaller number of abnormal scores on a test of early language milestones than children in the regular ultrasound groups.

The authors suggested that this may have been a statistical fluke—a seemingly significant result that showed up by chance because of the many end points examined in the study. An alternative explanation may be that women who had repeated ultrasound examinations may have had greater awareness of the study, which in turn enhanced parental attention, resulting in earlier language acquisition.

While this study showed no deleterious effects of repeated ultrasound examinations to the developing fetus, the authors cautioned that contemporary ultrasound instruments have higher power outputs than the instruments used in the study.

An 8-year follow-up study from a randomized, controlled trial of repeated prenatal ultrasound examinations found no evidence of any lasting harm to any aspect of child development.

The initial study demonstrated that infants exposed prenatally to five ultrasound imaging studies between 18 and 38 weeks' gestation had a significantly greater risk of low birth weight than children exposed to only a single ultrasound at 18 weeks of gestation.

Included in the follow-up analysis were 1,352 children who previously had been randomized to the regular ultrasound group and 1,362 children randomized to the intensive ultrasound group (Lancet 2004;364:2038-44).

After 8 years of repeated follow-up examinations, children in the two groups showed no statistically significant differences in a wide variety of developmental measures. These included measures of physical growth, toddler temperament, language development, and behavior, reported John P. Newham, M.D., of the University of Western Australia (Subiaco), and his colleagues.

The groups showed a statistically significant difference on only a single measure of child development. At 1 year of age children in the intensive ultrasound group showed a smaller number of abnormal scores on a test of early language milestones than children in the regular ultrasound groups.

The authors suggested that this may have been a statistical fluke—a seemingly significant result that showed up by chance because of the many end points examined in the study. An alternative explanation may be that women who had repeated ultrasound examinations may have had greater awareness of the study, which in turn enhanced parental attention, resulting in earlier language acquisition.

While this study showed no deleterious effects of repeated ultrasound examinations to the developing fetus, the authors cautioned that contemporary ultrasound instruments have higher power outputs than the instruments used in the study.

An 8-year follow-up study from a randomized, controlled trial of repeated prenatal ultrasound examinations found no evidence of any lasting harm to any aspect of child development.

The initial study demonstrated that infants exposed prenatally to five ultrasound imaging studies between 18 and 38 weeks' gestation had a significantly greater risk of low birth weight than children exposed to only a single ultrasound at 18 weeks of gestation.

Included in the follow-up analysis were 1,352 children who previously had been randomized to the regular ultrasound group and 1,362 children randomized to the intensive ultrasound group (Lancet 2004;364:2038-44).

After 8 years of repeated follow-up examinations, children in the two groups showed no statistically significant differences in a wide variety of developmental measures. These included measures of physical growth, toddler temperament, language development, and behavior, reported John P. Newham, M.D., of the University of Western Australia (Subiaco), and his colleagues.

The groups showed a statistically significant difference on only a single measure of child development. At 1 year of age children in the intensive ultrasound group showed a smaller number of abnormal scores on a test of early language milestones than children in the regular ultrasound groups.

The authors suggested that this may have been a statistical fluke—a seemingly significant result that showed up by chance because of the many end points examined in the study. An alternative explanation may be that women who had repeated ultrasound examinations may have had greater awareness of the study, which in turn enhanced parental attention, resulting in earlier language acquisition.

While this study showed no deleterious effects of repeated ultrasound examinations to the developing fetus, the authors cautioned that contemporary ultrasound instruments have higher power outputs than the instruments used in the study.

SANTA FE, N.M. – It's been said that sex reduces stress, but all sexual activity is apparently not created equal.

In a laboratory test intended to induce extreme stress, healthy subjects who reported engaging in penile-vaginal intercourse during the previous 2 weeks experienced significantly smaller increases in blood pressure than those who reported masturbating or engaging in noncoital sexual activity, Stuart Brody, Ph.D., said at the annual meeting of the Society for Psychophysiological Research.

The subjects included 24 women and 22 men aged 19-37 years who were in the placebo arm of a larger study of the effects of vitamin C, said Dr. Brody of the University of Tübingen (Germany). They completed daily diaries about their sexual activities for a period of 2 weeks, and then their systolic and diastolic blood pressures were measured before, during, and after participating in the Trier Social Stress Test.

In this test, subjects are given 10 minutes to prepare an oral presentation on their job qualifications. After this preparatory period, they are ushered into a room where two examiners listen critically to the presentation. Subjects are then asked to perform mental calculations.

People who reported engaging only in penile-vaginal intercourse during the previous 14 days experienced significantly lower systolic blood pressure during the most stressful part of this test than did those who engaged in no sexual activity, masturbation, or noncoital intercourse.

The peak systolic blood pressure for the intercourse-only group averaged 130 mm Hg, while the other groups' averages ranged from 143 mm Hg to 165 mm Hg, which Dr. Brody described as “an enormous difference.” The effects on diastolic blood pressure were not as dramatic.

The magnitude of this effect was much greater than that reported in other studies. The beneficial effect of penile-vaginal intercourse on systolic blood pressure in the Trier Social Stress Test is apparently more pronounced than any other intervention, including whether the subjects smoke or have a family history of hypertension; whether they're using ACE inhibitors, β-blockers, or oral contraceptives; or whether they exercise, are depressed, or are in marital distress, he said.

The beneficial effect of penile-vaginal intercourse on blood pressure seemed to disappear in people who also engaged in masturbation or noncoital intercourse during the 14-day period.

The statistical significance of the results was not affected if participants had ever engaged in homosexual activity, and the groups did not differ on measures of neuroticism, extraversion, or anxiety.

Dr. Brody described his results as politically incorrect: “The politically correct thing is to parrot the ideology first espoused by Kinsey and also by Herbert Marcuse, which is that all forms of sex are equivalent, except that intercourse is worse because it's part of the patriarchal power structure.”

SANTA FE, N.M. – It's been said that sex reduces stress, but all sexual activity is apparently not created equal.

In a laboratory test intended to induce extreme stress, healthy subjects who reported engaging in penile-vaginal intercourse during the previous 2 weeks experienced significantly smaller increases in blood pressure than those who reported masturbating or engaging in noncoital sexual activity, Stuart Brody, Ph.D., said at the annual meeting of the Society for Psychophysiological Research.

The subjects included 24 women and 22 men aged 19-37 years who were in the placebo arm of a larger study of the effects of vitamin C, said Dr. Brody of the University of Tübingen (Germany). They completed daily diaries about their sexual activities for a period of 2 weeks, and then their systolic and diastolic blood pressures were measured before, during, and after participating in the Trier Social Stress Test.

In this test, subjects are given 10 minutes to prepare an oral presentation on their job qualifications. After this preparatory period, they are ushered into a room where two examiners listen critically to the presentation. Subjects are then asked to perform mental calculations.

People who reported engaging only in penile-vaginal intercourse during the previous 14 days experienced significantly lower systolic blood pressure during the most stressful part of this test than did those who engaged in no sexual activity, masturbation, or noncoital intercourse.

The peak systolic blood pressure for the intercourse-only group averaged 130 mm Hg, while the other groups' averages ranged from 143 mm Hg to 165 mm Hg, which Dr. Brody described as “an enormous difference.” The effects on diastolic blood pressure were not as dramatic.

The magnitude of this effect was much greater than that reported in other studies. The beneficial effect of penile-vaginal intercourse on systolic blood pressure in the Trier Social Stress Test is apparently more pronounced than any other intervention, including whether the subjects smoke or have a family history of hypertension; whether they're using ACE inhibitors, β-blockers, or oral contraceptives; or whether they exercise, are depressed, or are in marital distress, he said.

The beneficial effect of penile-vaginal intercourse on blood pressure seemed to disappear in people who also engaged in masturbation or noncoital intercourse during the 14-day period.

The statistical significance of the results was not affected if participants had ever engaged in homosexual activity, and the groups did not differ on measures of neuroticism, extraversion, or anxiety.

Dr. Brody described his results as politically incorrect: “The politically correct thing is to parrot the ideology first espoused by Kinsey and also by Herbert Marcuse, which is that all forms of sex are equivalent, except that intercourse is worse because it's part of the patriarchal power structure.”

SANTA FE, N.M. – It's been said that sex reduces stress, but all sexual activity is apparently not created equal.

In a laboratory test intended to induce extreme stress, healthy subjects who reported engaging in penile-vaginal intercourse during the previous 2 weeks experienced significantly smaller increases in blood pressure than those who reported masturbating or engaging in noncoital sexual activity, Stuart Brody, Ph.D., said at the annual meeting of the Society for Psychophysiological Research.

The subjects included 24 women and 22 men aged 19-37 years who were in the placebo arm of a larger study of the effects of vitamin C, said Dr. Brody of the University of Tübingen (Germany). They completed daily diaries about their sexual activities for a period of 2 weeks, and then their systolic and diastolic blood pressures were measured before, during, and after participating in the Trier Social Stress Test.

In this test, subjects are given 10 minutes to prepare an oral presentation on their job qualifications. After this preparatory period, they are ushered into a room where two examiners listen critically to the presentation. Subjects are then asked to perform mental calculations.

People who reported engaging only in penile-vaginal intercourse during the previous 14 days experienced significantly lower systolic blood pressure during the most stressful part of this test than did those who engaged in no sexual activity, masturbation, or noncoital intercourse.

The peak systolic blood pressure for the intercourse-only group averaged 130 mm Hg, while the other groups' averages ranged from 143 mm Hg to 165 mm Hg, which Dr. Brody described as “an enormous difference.” The effects on diastolic blood pressure were not as dramatic.

The magnitude of this effect was much greater than that reported in other studies. The beneficial effect of penile-vaginal intercourse on systolic blood pressure in the Trier Social Stress Test is apparently more pronounced than any other intervention, including whether the subjects smoke or have a family history of hypertension; whether they're using ACE inhibitors, β-blockers, or oral contraceptives; or whether they exercise, are depressed, or are in marital distress, he said.

The beneficial effect of penile-vaginal intercourse on blood pressure seemed to disappear in people who also engaged in masturbation or noncoital intercourse during the 14-day period.

The statistical significance of the results was not affected if participants had ever engaged in homosexual activity, and the groups did not differ on measures of neuroticism, extraversion, or anxiety.

Dr. Brody described his results as politically incorrect: “The politically correct thing is to parrot the ideology first espoused by Kinsey and also by Herbert Marcuse, which is that all forms of sex are equivalent, except that intercourse is worse because it's part of the patriarchal power structure.”

Famed British author Iris Murdoch suffered from Alzheimer's disease before her death in 1999, and her final novel contains evidence of her increasing disability, according to an analysis by Peter Garrard, M.D., of University College, London, and his colleagues.

The last final work, “Jackson's Dilemma,” published in 1995, was characterized by simplified language and a dwindling vocabulary, at least compared with “Under the Net,” her first novel, published in 1954, and “The Sea, the Sea,” the Booker Prize-winning novel published in 1978 at the height of her creative powers, wrote Dr. Garrard of the college's Institute of Cognitive Neuroscience (Brain [online] 2004;www.brain.oupjournals.org/cgi/reprint/awh341v1

Critics' reaction to “Jackson's Dilemma” proved lukewarm, and the author later revealed that she had struggled with “writer's block” while writing it.

The investigators digitized portions of the three books and used specialized software to analyze, among other things, the frequency of words by word type. Of the three books, “Jackson's Dilemma” used the fewest word types, “The Sea, the Sea” used the most, and “Under the Net” used an intermediate number of word types. This suggests that her vocabulary was enriched between 1954 and 1978, and impoverished between 1978 and 1995.

In contrast to the relatively impoverished lexical characteristics of “Jackson's Dilemma,” the investigators found no difference in its syntactic characteristics–its grammar and structure. This is consistent with other studies of early Alzheimer's disease, in which many sufferers have trouble finding words while producing perfectly well-formed sentences.

Dr. Garrard and his colleagues wrote that their findings have clinical and theoretical implications. “From a clinical point of view, the results support the idea that the occurrence in the brain of Alzheimer's disease pathology may predate the onset of the earliest overt symptoms by years, or even decades,” they wrote. “This in turn raises the possibility that an intellect of exceptional premorbid quality and/or a lifetime's engagement with intellectual work may either protect against cognitive deterioration or enable it to be masked.”

Soon after the publication of “Jackson's Dilemma,” Ms. Murdoch was diagnosed with Alzheimer's disease at the age of 76. She died 3 years later, and the Alzheimer's diagnosis was confirmed post mortem.

Famed British author Iris Murdoch suffered from Alzheimer's disease before her death in 1999, and her final novel contains evidence of her increasing disability, according to an analysis by Peter Garrard, M.D., of University College, London, and his colleagues.

The last final work, “Jackson's Dilemma,” published in 1995, was characterized by simplified language and a dwindling vocabulary, at least compared with “Under the Net,” her first novel, published in 1954, and “The Sea, the Sea,” the Booker Prize-winning novel published in 1978 at the height of her creative powers, wrote Dr. Garrard of the college's Institute of Cognitive Neuroscience (Brain [online] 2004;www.brain.oupjournals.org/cgi/reprint/awh341v1

Critics' reaction to “Jackson's Dilemma” proved lukewarm, and the author later revealed that she had struggled with “writer's block” while writing it.

The investigators digitized portions of the three books and used specialized software to analyze, among other things, the frequency of words by word type. Of the three books, “Jackson's Dilemma” used the fewest word types, “The Sea, the Sea” used the most, and “Under the Net” used an intermediate number of word types. This suggests that her vocabulary was enriched between 1954 and 1978, and impoverished between 1978 and 1995.

In contrast to the relatively impoverished lexical characteristics of “Jackson's Dilemma,” the investigators found no difference in its syntactic characteristics–its grammar and structure. This is consistent with other studies of early Alzheimer's disease, in which many sufferers have trouble finding words while producing perfectly well-formed sentences.

Dr. Garrard and his colleagues wrote that their findings have clinical and theoretical implications. “From a clinical point of view, the results support the idea that the occurrence in the brain of Alzheimer's disease pathology may predate the onset of the earliest overt symptoms by years, or even decades,” they wrote. “This in turn raises the possibility that an intellect of exceptional premorbid quality and/or a lifetime's engagement with intellectual work may either protect against cognitive deterioration or enable it to be masked.”

Soon after the publication of “Jackson's Dilemma,” Ms. Murdoch was diagnosed with Alzheimer's disease at the age of 76. She died 3 years later, and the Alzheimer's diagnosis was confirmed post mortem.

Famed British author Iris Murdoch suffered from Alzheimer's disease before her death in 1999, and her final novel contains evidence of her increasing disability, according to an analysis by Peter Garrard, M.D., of University College, London, and his colleagues.

The last final work, “Jackson's Dilemma,” published in 1995, was characterized by simplified language and a dwindling vocabulary, at least compared with “Under the Net,” her first novel, published in 1954, and “The Sea, the Sea,” the Booker Prize-winning novel published in 1978 at the height of her creative powers, wrote Dr. Garrard of the college's Institute of Cognitive Neuroscience (Brain [online] 2004;www.brain.oupjournals.org/cgi/reprint/awh341v1

Critics' reaction to “Jackson's Dilemma” proved lukewarm, and the author later revealed that she had struggled with “writer's block” while writing it.

The investigators digitized portions of the three books and used specialized software to analyze, among other things, the frequency of words by word type. Of the three books, “Jackson's Dilemma” used the fewest word types, “The Sea, the Sea” used the most, and “Under the Net” used an intermediate number of word types. This suggests that her vocabulary was enriched between 1954 and 1978, and impoverished between 1978 and 1995.

In contrast to the relatively impoverished lexical characteristics of “Jackson's Dilemma,” the investigators found no difference in its syntactic characteristics–its grammar and structure. This is consistent with other studies of early Alzheimer's disease, in which many sufferers have trouble finding words while producing perfectly well-formed sentences.

Dr. Garrard and his colleagues wrote that their findings have clinical and theoretical implications. “From a clinical point of view, the results support the idea that the occurrence in the brain of Alzheimer's disease pathology may predate the onset of the earliest overt symptoms by years, or even decades,” they wrote. “This in turn raises the possibility that an intellect of exceptional premorbid quality and/or a lifetime's engagement with intellectual work may either protect against cognitive deterioration or enable it to be masked.”

Soon after the publication of “Jackson's Dilemma,” Ms. Murdoch was diagnosed with Alzheimer's disease at the age of 76. She died 3 years later, and the Alzheimer's diagnosis was confirmed post mortem.

PHOENIX, ARIZ. – Four out of five children and adolescents under psychiatric treatment were receiving pharmacotherapy in a recent study, and slightly more than half of these received more than one psychiatric medication, Joyce C. West, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

The use of concomitant pharmacotherapy was significantly higher among patients with co-occurring Axis I, II, or III disorders than among those without. But among children and adolescents with only a single identified disorder, about 40% were receiving two or more medications, Dr. West of the American Psychiatric Institute for Research and Education in Arlington, Va., told this newspaper.

“Given that we don't know about the efficacy or the potential safety and risks of concomitant pharmacotherapy in this population, the overall pattern highlights the need for more research,” she said.

Data for the study came from the American Psychiatric Association's Practice Research Network 1997 and 1999 studies of psychiatric patients and treatment.

These studies surveyed 754 psychiatrists who provided detailed data on a systematically selected national sample of 3,088 patients, 392 of whom were younger than 18 years.

Overall, 84% of these patients were receiving psychiatric medications, and 52% were receiving two or more psychiatric medications. Among all the child and adolescent patients, 10.2% were receiving three psychiatric medications, and 2.9% were receiving four or more psychiatric medications.

Antidepressants, used by 52% of the patients, were the most common of these medications, followed by stimulants (41%), antipsychotics (23%), antimanic agents (23%), and antianxiety medications (8%).

Patients who had been diagnosed with bipolar disorder, schizophrenia, and disruptive behavioral disorders were the most likely to be taking two or more psychiatric medications.

Rates of polypharmacy in patients with those diagnoses were 87%, 70%, and 61%, respectively. Polypharmacy was least common in patients with anxiety disorders, 44% of whom were receiving multiple medications.

Among the patients taking two or more psychiatric medications, an antidepressant together with a stimulant was the most common combination, seen in 21% of the patients.

About 11% of polypharmacy patients were receiving an antidepressant and an antipsychotic, and 7% were receiving an antidepressant and an antimanic agent, Dr. West said.

PHOENIX, ARIZ. – Four out of five children and adolescents under psychiatric treatment were receiving pharmacotherapy in a recent study, and slightly more than half of these received more than one psychiatric medication, Joyce C. West, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

The use of concomitant pharmacotherapy was significantly higher among patients with co-occurring Axis I, II, or III disorders than among those without. But among children and adolescents with only a single identified disorder, about 40% were receiving two or more medications, Dr. West of the American Psychiatric Institute for Research and Education in Arlington, Va., told this newspaper.

“Given that we don't know about the efficacy or the potential safety and risks of concomitant pharmacotherapy in this population, the overall pattern highlights the need for more research,” she said.

Data for the study came from the American Psychiatric Association's Practice Research Network 1997 and 1999 studies of psychiatric patients and treatment.

These studies surveyed 754 psychiatrists who provided detailed data on a systematically selected national sample of 3,088 patients, 392 of whom were younger than 18 years.

Overall, 84% of these patients were receiving psychiatric medications, and 52% were receiving two or more psychiatric medications. Among all the child and adolescent patients, 10.2% were receiving three psychiatric medications, and 2.9% were receiving four or more psychiatric medications.

Antidepressants, used by 52% of the patients, were the most common of these medications, followed by stimulants (41%), antipsychotics (23%), antimanic agents (23%), and antianxiety medications (8%).

Patients who had been diagnosed with bipolar disorder, schizophrenia, and disruptive behavioral disorders were the most likely to be taking two or more psychiatric medications.

Rates of polypharmacy in patients with those diagnoses were 87%, 70%, and 61%, respectively. Polypharmacy was least common in patients with anxiety disorders, 44% of whom were receiving multiple medications.

Among the patients taking two or more psychiatric medications, an antidepressant together with a stimulant was the most common combination, seen in 21% of the patients.

About 11% of polypharmacy patients were receiving an antidepressant and an antipsychotic, and 7% were receiving an antidepressant and an antimanic agent, Dr. West said.

PHOENIX, ARIZ. – Four out of five children and adolescents under psychiatric treatment were receiving pharmacotherapy in a recent study, and slightly more than half of these received more than one psychiatric medication, Joyce C. West, Ph.D., said at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.

The use of concomitant pharmacotherapy was significantly higher among patients with co-occurring Axis I, II, or III disorders than among those without. But among children and adolescents with only a single identified disorder, about 40% were receiving two or more medications, Dr. West of the American Psychiatric Institute for Research and Education in Arlington, Va., told this newspaper.

“Given that we don't know about the efficacy or the potential safety and risks of concomitant pharmacotherapy in this population, the overall pattern highlights the need for more research,” she said.

Data for the study came from the American Psychiatric Association's Practice Research Network 1997 and 1999 studies of psychiatric patients and treatment.

These studies surveyed 754 psychiatrists who provided detailed data on a systematically selected national sample of 3,088 patients, 392 of whom were younger than 18 years.

Overall, 84% of these patients were receiving psychiatric medications, and 52% were receiving two or more psychiatric medications. Among all the child and adolescent patients, 10.2% were receiving three psychiatric medications, and 2.9% were receiving four or more psychiatric medications.

Antidepressants, used by 52% of the patients, were the most common of these medications, followed by stimulants (41%), antipsychotics (23%), antimanic agents (23%), and antianxiety medications (8%).

Patients who had been diagnosed with bipolar disorder, schizophrenia, and disruptive behavioral disorders were the most likely to be taking two or more psychiatric medications.

Rates of polypharmacy in patients with those diagnoses were 87%, 70%, and 61%, respectively. Polypharmacy was least common in patients with anxiety disorders, 44% of whom were receiving multiple medications.

Among the patients taking two or more psychiatric medications, an antidepressant together with a stimulant was the most common combination, seen in 21% of the patients.

About 11% of polypharmacy patients were receiving an antidepressant and an antipsychotic, and 7% were receiving an antidepressant and an antimanic agent, Dr. West said.

SPOKANE, WASH. — Combined chin-jowl implants give a better, longer-lasting cosmetic result than central chin implants alone, Greg S. Morganroth, M.D., said at the annual Pacific Northwest Dermatological Conference.

Central chin implants provide only frontal projection and can shift over time. The chin-jowl implants, on the other hand, are anchored laterally and are better retained. They can improve the appearance of the anterior mandibular groove (also called the prejowl sulcus) and can be sculpted to help restore facial symmetry in patients with hemifacial atrophy.

"This procedure can be performed solo, or it can be integrated into your neck lipo," said Dr. Morganroth, a dermatologic surgeon in private practice in Mountain View, Calif. "It can be integrated into your facelifts. It makes a huge difference because part of that great facial result is having that nice, sharp jawline."

When combined with a "facial lipolift" (which includes neck and jowl liposuction, a laser peel, and a short-scar facelift), implants can rival the results of a traditional surgical facelift. Unlike a traditional facelift, however, the full implant procedure can be performed in 2-3 hours under local anesthesia and allows patients to return to work in a week.

Any patient whose recessed chin is less than 2 cm behind his or her forehead is a candidate for a chin-jowl implant. Patients whose chins are more than 2 cm behind the forehead will more likely require maxillofacial surgery to bring the jaw forward.

The procedure is relatively simple, Dr. Morganroth said at the conference, sponsored by the Washington State Dermatology Association. It requires the same instrument pack a dermatologist would use for the excision of a basal cell carcinoma, with the addition of a Freer elevator. For anesthesia, he performs a mental nerve block followed by five or six injections of 1% lidocaine with 1:100,000 epinephrine into the periosteum along the chin.

The surgery starts with a 1.5- to 2-cm submental incision down to the periosteum that is elevated to allow the creation of pockets on the right and left sides of the mandible. These pockets must extend at least 5.3 cm laterally and must be slightly larger than the implant.

The surgeon then positions the implant along the mandible, checking for symmetrical placement. One or two sutures anchor the central part of the implant to the underlying periosteum so the implant won't shift upward. All that remains then is to suture the periosteal, muscular, subcutaneous, and skin layers.

Dr. Morganroth said that in his hands the procedure is very safe, although all patients experience temporary bruising and swelling. Other potential complications include bone resorption under the implant, slurred speech from swelling in the mentalis muscle, infection, hematoma, and injury to the mental nerve or the marginal mandibular nerve. Asymmetry is also a possibility, as are migration of the implant, hypertrophic scarring, and an overcorrected appearance.

Central chin implants provide only frontal projection, making this patient a good candidate for combined implants.

The patient is shown after neck and jowl liposuction combined with a chin-jowl subperiosteal implant. Photos courtesy Dr. Greg S. Morganroth

SPOKANE, WASH. — Combined chin-jowl implants give a better, longer-lasting cosmetic result than central chin implants alone, Greg S. Morganroth, M.D., said at the annual Pacific Northwest Dermatological Conference.

Central chin implants provide only frontal projection and can shift over time. The chin-jowl implants, on the other hand, are anchored laterally and are better retained. They can improve the appearance of the anterior mandibular groove (also called the prejowl sulcus) and can be sculpted to help restore facial symmetry in patients with hemifacial atrophy.

"This procedure can be performed solo, or it can be integrated into your neck lipo," said Dr. Morganroth, a dermatologic surgeon in private practice in Mountain View, Calif. "It can be integrated into your facelifts. It makes a huge difference because part of that great facial result is having that nice, sharp jawline."

When combined with a "facial lipolift" (which includes neck and jowl liposuction, a laser peel, and a short-scar facelift), implants can rival the results of a traditional surgical facelift. Unlike a traditional facelift, however, the full implant procedure can be performed in 2-3 hours under local anesthesia and allows patients to return to work in a week.

Any patient whose recessed chin is less than 2 cm behind his or her forehead is a candidate for a chin-jowl implant. Patients whose chins are more than 2 cm behind the forehead will more likely require maxillofacial surgery to bring the jaw forward.

The procedure is relatively simple, Dr. Morganroth said at the conference, sponsored by the Washington State Dermatology Association. It requires the same instrument pack a dermatologist would use for the excision of a basal cell carcinoma, with the addition of a Freer elevator. For anesthesia, he performs a mental nerve block followed by five or six injections of 1% lidocaine with 1:100,000 epinephrine into the periosteum along the chin.

The surgery starts with a 1.5- to 2-cm submental incision down to the periosteum that is elevated to allow the creation of pockets on the right and left sides of the mandible. These pockets must extend at least 5.3 cm laterally and must be slightly larger than the implant.

The surgeon then positions the implant along the mandible, checking for symmetrical placement. One or two sutures anchor the central part of the implant to the underlying periosteum so the implant won't shift upward. All that remains then is to suture the periosteal, muscular, subcutaneous, and skin layers.

Dr. Morganroth said that in his hands the procedure is very safe, although all patients experience temporary bruising and swelling. Other potential complications include bone resorption under the implant, slurred speech from swelling in the mentalis muscle, infection, hematoma, and injury to the mental nerve or the marginal mandibular nerve. Asymmetry is also a possibility, as are migration of the implant, hypertrophic scarring, and an overcorrected appearance.

Central chin implants provide only frontal projection, making this patient a good candidate for combined implants.

The patient is shown after neck and jowl liposuction combined with a chin-jowl subperiosteal implant. Photos courtesy Dr. Greg S. Morganroth

SPOKANE, WASH. — Combined chin-jowl implants give a better, longer-lasting cosmetic result than central chin implants alone, Greg S. Morganroth, M.D., said at the annual Pacific Northwest Dermatological Conference.

Central chin implants provide only frontal projection and can shift over time. The chin-jowl implants, on the other hand, are anchored laterally and are better retained. They can improve the appearance of the anterior mandibular groove (also called the prejowl sulcus) and can be sculpted to help restore facial symmetry in patients with hemifacial atrophy.

"This procedure can be performed solo, or it can be integrated into your neck lipo," said Dr. Morganroth, a dermatologic surgeon in private practice in Mountain View, Calif. "It can be integrated into your facelifts. It makes a huge difference because part of that great facial result is having that nice, sharp jawline."

When combined with a "facial lipolift" (which includes neck and jowl liposuction, a laser peel, and a short-scar facelift), implants can rival the results of a traditional surgical facelift. Unlike a traditional facelift, however, the full implant procedure can be performed in 2-3 hours under local anesthesia and allows patients to return to work in a week.

Any patient whose recessed chin is less than 2 cm behind his or her forehead is a candidate for a chin-jowl implant. Patients whose chins are more than 2 cm behind the forehead will more likely require maxillofacial surgery to bring the jaw forward.

The procedure is relatively simple, Dr. Morganroth said at the conference, sponsored by the Washington State Dermatology Association. It requires the same instrument pack a dermatologist would use for the excision of a basal cell carcinoma, with the addition of a Freer elevator. For anesthesia, he performs a mental nerve block followed by five or six injections of 1% lidocaine with 1:100,000 epinephrine into the periosteum along the chin.

The surgery starts with a 1.5- to 2-cm submental incision down to the periosteum that is elevated to allow the creation of pockets on the right and left sides of the mandible. These pockets must extend at least 5.3 cm laterally and must be slightly larger than the implant.

The surgeon then positions the implant along the mandible, checking for symmetrical placement. One or two sutures anchor the central part of the implant to the underlying periosteum so the implant won't shift upward. All that remains then is to suture the periosteal, muscular, subcutaneous, and skin layers.

Dr. Morganroth said that in his hands the procedure is very safe, although all patients experience temporary bruising and swelling. Other potential complications include bone resorption under the implant, slurred speech from swelling in the mentalis muscle, infection, hematoma, and injury to the mental nerve or the marginal mandibular nerve. Asymmetry is also a possibility, as are migration of the implant, hypertrophic scarring, and an overcorrected appearance.

Central chin implants provide only frontal projection, making this patient a good candidate for combined implants.

The patient is shown after neck and jowl liposuction combined with a chin-jowl subperiosteal implant. Photos courtesy Dr. Greg S. Morganroth